“Germany is a federal parliamentary republic, consisting of 16 states (Figure 1.1). Each state has a constitution that is consistent with the federal, democratic and social principles embodied in the national constitution, which is known as the Basic Law, or Grundgesetz.

“The constitutionally defined legislative bodies are (a) the Bundestag (“Federal Assembly”) and (b) the Bundesrat (“Federal Council”):

“a. The members of the Bundestag are elected by the people every four years.* The current members of parliament in the Federal Assembly were last elected in September 2017 and form six political parties, namely the Christian Democratic Union/Christian Social Union (Christlich Demokratische Union/Christlich-Soziale Union – CDU/CSU) holding 246 seats, the Social Democratic Party (Sozialdemokratische Partei Deutschlands – SPD) holding 152 seats, the Alternative for Germany (Alternative für Deutschland – AfD) holding 90 seats, the Free Democratic Party (Freie Demokratische Partei – FDP) holding 80 seats, the Left Party (Die Linke) holding 69 seats, and Alliance 90/The Greens (Bündnis 90/Die Grünen) holding 67 seats. The main functions of the Bundestag are to pass laws, elect the chancellor and hold the government accountable (Deutscher Bundestag, 2019).

“b. The Bundesrat, which represents the sixteen states, does not consist of directly elected representatives, but rather of representatives from each of the sixteen state governments, each having between three and six of a total of 69 votes. The main function of the Bundesrat is to deliberate and enact laws passed by the Bundestag.

“The president of Germany (since February 2017 Frank-Walter Steinmeier) is elected for five years by an assembly consisting of the members of the Bundestag and an equal number of representatives from the states according to the size of their population. The president’s role is largely ceremonial, the chief tasks being to sign new laws, to formally appoint the chancellor and the federal ministers and to serve as head of state.”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.

“Legislative authority is exercised by the 16 states except in areas reserved explicitly for the federal level. At the federal level, legislative authority falls into two different categories: (1) exclusive legislation (pertaining mainly to foreign policy, defence, currency, citizenship, trade, aviation and some elements of taxation) and (2) concurrent legislation. For areas that fall neither within the exclusive remit of the federal government nor within that of the states (for example, criminal law, road traffic laws and consumer protection), the states may exercise legislative authority only in cases where the federal government has not already done so. In principle, the states can fill in any gaps left by federal legislation or in areas not specified by the Basic Law. As an expression of their cultural sovereignty, they are responsible for almost all matters pertaining to culture and education (see Section 4.2.4 Training of health workers). Given this shared power, health care policy and legislation are formulated at both the federal and state level.”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and sixteen other nations.

Page last updated Jan. 25, 2023 by Doug McVay, Editor.